Test your knowledge

A patient attends surgery after an outpatient appointment. He has been prescribed a drug that you are unfamiliar with. On checking the BNF, you note that the drug has the inverted triangle symbol next to it. What does this symbol mean?

A – This drug is unlicensed and should not be routinely prescribed.
B – This drug should only be commenced in secondary care.
C – This drug requires early monitoring with blood tests.
D – This drug is a controlled drug.
E – Any adverse reaction to this drug (even minor reactions) should be reported using the Yellow Card Scheme.

A patient has requested a prescription for a drug they read about in the news. The drug is a new analgesic for neuropathic pain. This drug is widely available in some European countries, but is not licensed in the UK. Regarding unlicensed medications, which of the following is correct?

A – You should not prescribe unlicensed medications.
B – You can prescribe an unlicensed medication where an alternative, licensed medication that would be suitable is not available
C – Unlicensed medications should only be prescribed in secondary care
D – You can prescribe an unlicensed medication, but it should be treated as a private prescription
E – Prescriptions for unlicensed medications require regular monitoring via blood testing.

You notice that one of your eyes is red and a little sticky. Your vision is not affected. You are confident that this is a bacterial conjunctivitis. What would be the most suitable way to manage this?

A – Prescribe some chloramphenicol eye drops for yourself while at your training practice using a practice prescription pad.

B – Write a private prescription for chloramphenicol eye drops for yourself.
C – Make an appointment to see your own GP for an assessment.
D – Ask your trainer to have a look at your eye, so they can prescribe if appropriate.
E – Ask one of your fellow GP registrars from your training scheme to prescribe antibiotic eye drops for you.

1. The correct answer is E – Any adverse reaction to this drug (even a minor reaction) should be reported using the Yellow Card Scheme.

The inverted triangle symbol usually appears next to newly-licensed drugs, which are closely monitored. All adverse reactions should be reported to the Medicines and Healthcare products Regulatory Agency (MHRA) using the Yellow Card Scheme. Established drugs differ in that only serious adverse drug reactions need to be reported.

2. The correct answer is B – You can prescribe an unlicensed medication where an alternative, licensed medication that would be suitable is not available.

GMC guidance also recommends that you are satisfied with the evidence base for using the medication and that you record your reasons for choosing an unlicensed drug. You should also take responsibility for the prescription, including any required monitoring, however not all unlicensed medications will require blood testing (option E).

3. The correct answer is C – Make an appointment to see your own GP for an assessment.

GMC guidance states “Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship.” (Good Medical Practice, GMC 2013). GMC guidance on prescribing recommends getting an independent medical opinion when doctors or those close to them require prescription medication. This is to maintain objectivity in decision making.

Dr Mahibur Rahman is the medical director of Emedica, and works as a portfolio GP in the West Midlands. He is the course director for the Emedica AKT and CSA Preparation courses, and has helped hundreds of GP trainees achieve success in their MRCGP AKT and CSA examinations.

MPS members can get a £20 discount off the Emedica MRCGP courses. Details of the courses are available at www.emedica.co.uk

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